Fojas Ma Conchitina, Southerland Lauren T, Phieffer Laura S, Stephens Julie A, Srivastava Tanya, Ing Steven W
Division of Endocrinology, Diabetes and Metabolism, The Ohio State University-Wexner Medical Center, Columbus, OH, USA.
Department of Emergency Medicine, The Ohio State University-Wexner Medical Center, Columbus, OH, USA.
Arch Osteoporos. 2017 Dec;12(1):16. doi: 10.1007/s11657-017-0307-6. Epub 2017 Feb 2.
There are care gaps in the evaluation and treatment of osteoporosis after a fragility fracture. The Joint Commission is considering adoption of core measures. We compared compliance between two secondary fracture prevention programs in our institution. Incorporating strengths of both may provide the best outcomes for secondary fracture prevention.
There are significant care gaps in the evaluation and treatment of osteoporosis after occurrence of fragility fracture. The Joint Commission is considering adoption of a core measure set on osteoporosis-associated fractures, including laboratory assessment, bone density testing, and osteoporosis pharmacologic therapy. We compared compliance to these proposed measures between two secondary fracture prevention programs in patients hospitalized for acute fracture in an open medical system.
We conducted a retrospective, single center medical records review of a nurse practitioner-led Fracture Liaison Service (FLS), a physician-led Fracture Prevention Program (FPP), and a historical time without any secondary fracture prevention program (Usual Care) for baseline care. Primary outcomes were the completion of five laboratory tests (calcium, 25-hydroxy vitamin D, renal function, liver function, and complete blood count), order placement and completion of dual x-ray absorptiometry (DXA) scan within 3 months, prescription of osteoporosis medication within 3 months, and medication adherence at 6 months after hospital discharge.
Completion of all five laboratory tests was higher in FPP versus FLS (84.7 vs. 36.9%, p < 0.001). DXA scan completion was higher in FPP than FLS but not statistically significant (66.7 vs. 54.9%, p = 0.11). Medication prescription at 3 months and adherence at 6 months were significantly higher in FPP versus FLS (65.3 vs. 24.0%, p < 0.001 and 70.8 vs. 27.7%, p < 0.001, respectively).
Incorporating strengths of both FLS (care coordination) and FPP (physician direction) may provide the best outcomes for secondary fracture prevention by ensuring laboratory and DXA testing and initiating osteoporosis medication.
脆性骨折后骨质疏松症的评估和治疗存在护理差距。联合委员会正在考虑采用核心措施。我们比较了我院两个二级骨折预防项目的依从性。结合两者的优势可能为二级骨折预防带来最佳效果。
脆性骨折发生后骨质疏松症的评估和治疗存在显著的护理差距。联合委员会正在考虑采用一套关于骨质疏松症相关骨折的核心措施，包括实验室评估、骨密度检测和骨质疏松症药物治疗。我们在一个开放医疗系统中，比较了因急性骨折住院患者的两个二级骨折预防项目对这些拟议措施的依从性。
我们对由执业护士主导的骨折联络服务（FLS）、由医生主导的骨折预防项目（FPP）以及一个没有任何二级骨折预防项目的历史时期（常规护理）进行了回顾性、单中心病历审查，以获取基线护理情况。主要结局包括五项实验室检查（钙、25-羟维生素D、肾功能、肝功能和全血细胞计数）的完成情况、在3个月内开具并完成双能X线吸收法（DXA）扫描、在3个月内开具骨质疏松症药物处方以及出院后6个月的药物依从性。
FPP组五项实验室检查全部完成的比例高于FLS组（84.7%对36.9%，p<0.001）。FPP组DXA扫描完成率高于FLS组，但差异无统计学意义（66.7%对54.9%，p=0.11）。FPP组在3个月时的药物处方率和6个月时的依从率显著高于FLS组（分别为65.3%对24.0%，p<0.001；70.8%对27.7%，p<0.001）。
结合FLS（护理协调）和FPP（医生指导）的优势可能通过确保实验室和DXA检测以及启动骨质疏松症药物治疗，为二级骨折预防带来最佳效果。
